Med/Surg Renal
A client develops kidney damage as a result of a transfusion reaction. What is the most significant clinical response that the nurse will assess when determining kidney damage? Glycosuria Blood in the urine Decreased urinary output Acute pain over the kidney
Decreased urinary output Diminished renal function usually is evidenced by a decrease in urine output to less than 100 to 400 mL/24 hours. Glycosuria is unrelated to a transfusion reaction. Although blood in the urine and acute pain over the kidney are related to the renal system and are signs of an acute hemolytic reaction, their presence does not necessarily indicate kidney damage.
A client with chronic renal failure has been on hemodialysis for 2 years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely for which reason? An attempt to punish the nursing staff A constructive method of accepting reality A defense against underlying depression and fear An effort to maintain life and to live it as fully as possible
a defense against underlying depression and fear Both hostility and noncompliance are forms of anger that are associated with grieving. The client's behavior is not a conscious attempt to hurt others but a way to relieve and reduce anxiety within the self. The client's behavior is a self-destructive method of coping, which can result in death. The client's behavior is an effort to maintain control over a situation that is really controlling the client; it is an unconscious method of coping, and noncompliance may be a form of denial.
A nurse is assessing the urine of a client with a urinary tract infection. For which characteristic should the nurse assess each specimen of urine? Clarity Viscosity Glucose level Specific gravity
clarity Cloudy urine usually indicates drainage associated with infection. Viscosity is a characteristic that is not measurable in urine. Urinary glucose levels are not affected by urinary tract infections. Specific gravity yields information related to fluid balance.
Which findings in the older client are associated with a urinary tract infection (UTI)? Select all that apply. Fever Urgency Confusion Incontinence Slight rise in temperature
confusion, incontinence, slight rise in temperature An older client with a urinary tract infection (UTI) is likely to appear confused. An older client may experience incontinence while a younger client may experience urgency. The older client may develop a slight rise in temperature. The classic symptoms of a UTI in a younger client are fever, dysuria, and urgency.
When receiving hemodialysis, the client may develop hyponatremia. For which clinical findings associated with hyponatremia should the nurse assess the client? Select all that apply. Diarrhea Seizures Chvostek sign Cardiac dysrhythmias Increased temperature
diarrhea, seizures Sodium is the most abundant cation in the extracellular fluid and functions as part of the sodium/potassium pump. In the presence of a deficit, the client will exhibit confusion, lethargy, diarrhea, and seizures. Spasm of the facial muscles following a tap over the facial nerve (Chvostek sign) indicates hypocalcemia. Cardiac dysrhythmias are associated with increases or decreases in potassium and calcium. An increase in body temperature reflects a possible infection, not an electrolyte imbalance.
A client with chronic kidney disease is receiving medication to manage anemia. Which primary goal should the nurse include in the care plan from this information? Prevention of uremic frost Prevention of chronic fatigue Prevention of tubular necrosis Prevention of dependent edema
prevention of chronic fatigue Kidney failure results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathologic condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.
A client with kidney dysfunction reports anorexia, itching, nausea, vomiting, and muscle cramps. Which renal complication do these symptoms indicate? Uremia Nephritis Nephrosis Renal colic
uremia Uremia is a condition caused by a buildup of nitrogenous waste products due to kidney impairment. It is characterized by anorexia, itching, nausea, vomiting, and muscle cramps. Nephritis is characterized by kidney inflammation. Nephrosis is a degenerative process in the kidney. Renal colic is characterized by pain that radiates into the groin, scrotum or labia, and perineal area.
A nurse is caring for a client who reports urinary problems, and the healthcare provider prescribes a cholinergic medication. Which urinary problem will this medication correct? Urinary frequency due to bladder spasticity Urinary retention due to bladder atony Pain due to urinary tract calculi Urinary urgency due to urinary tract infections
urinary retention due to bladder atony Cholinergics intensify and prolong the action of acetylcholine, which increases tone in the genitourinary tract, preventing urinary retention. Anticholinergics are prescribed for frequency and urgency associated with a spastic bladder. Cholinergics will not prevent renal calculi. Urinary tract infections are a secondary gain because cholinergics help prevent urinary retention that can lead to urinary tract infection, but this is not the primary purpose for administering a cholinergic.
A client who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. Which substance removal should the nurse share with the client? Blood Sodium Glucose Bacteria
sodium Sodium is an electrolyte that passes through the semipermeable membrane during hemodialysis. Red blood cells do not pass through the semipermeable membrane during hemodialysis. Glucose does not pass through the semipermeable membrane during hemodialysis. Bacteria do not pass through the semipermeable membrane during hemodialysis.
The registered nurse is preparing to assess a client's renal system. Which statement by the nurse indicates effective technique? "I must first palpate the client if a tumor is suspected." "I must first listen for normal pulse at the client's wrist region." "I must first auscultate the client and then proceed to percussion and palpation." "I must first examine tender abdominal areas and then proceed to nontender areas."
I must auscultate then percussion and palpation Palpation and percussion can cause an increase in normal bowel sounds and hide abdominal vascular sounds. Therefore it is wise to perform auscultation prior to percussion and palpation during clinical assessment of the renal system. Palpation should be avoided if a client is suspected of having a tumor because it could harm the client. It is more important as part of clinical assessment of the renal system to listen for bruit by auscultating over the renal artery. Bruit indicates renal artery stenosis. The nontender areas should be examined prior to tender areas to avoid confusion regarding radiating pain from the tender area being percussed.
A client who is to begin continuous ambulatory peritoneal dialysis asks the nurse what this entails. What information should the nurse include when answering the client's question? Hemodialysis and peritoneal dialysis will be done together. Peritoneal dialysis is performed in an ambulatory care clinic. About a quarter of a liter of dialysate is maintained in the peritoneal cavity. Constant contact is maintained between the dialysate and the peritoneal membrane.
constant contact is maintained between the dialysate and the peritoneal membrane Dialysate is introduced into the peritoneal cavity where fluids, electrolytes, and wastes are exchanged through the peritoneal membrane. Hemodialysis is not necessary with continuous ambulatory peritoneal dialysis. The client can dialyze alone in any location without the need for continuous technical supervision. About two liters, not one-quarter of a liter, of dialysate are maintained intraperitoneally and can be instilled and drained by the client.
A client arrives at a health clinic reporting hematuria, frequency, urgency, and pain on urination. Which diagnosis will the nurse most likely observe written in the client's medical record? Chronic glomerulonephritis Nephrotic syndrome Pyelonephritis Cystitis
cystitis Cystitis is an inflammation of the bladder that causes frequency and urgency of urination, pain on micturition, and hematuria. Chronic glomerulonephritis is a disease of the kidney that is associated with manifestations of systemic circulatory overload. Nephrotic syndrome is a condition of increased glomerular permeability characterized by severe proteinuria. Pyelonephritis is a diffuse, pyogenic infection of the pelvis and parenchyma of the kidney that causes flank pain, chills, fever, and weakness.
A client receiving hemodialysis has an external shunt for circulatory access. With which life-threatening complication associated with external cannulas should the nurse be most concerned? Infection Hemorrhage Skin breakdown Impaired circulation
hemorrhage Exsanguination (hemorrhage) can occur in a matter of minutes if cannulas are dislodged. Infection, skin breakdown, and impaired circulation are not life-threatening situations; preventing hemorrhage takes priority.
A nurse is caring for a client with a diagnosis of chronic kidney failure who has just been told by the primary healthcare provider that hemodialysis is necessary. Which clinical manifestation indicates the need for hemodialysis? Ascites Acidosis Hypertension Hyperkalemia
hyperkalemia Protein breakdown liberates cellular potassium ions, leading to hyperkalemia, which can cause a cardiac dysrhythmia and standstill. The failure of the kidneys to maintain a balance of potassium is one of the main indications for dialysis. Ascites occurs in liver disease and is not an indication for dialysis. Dialysis is not the usual treatment for acidosis; usually this responds to administration of alkaline drugs. Dialysis is not a treatment for hypertension; this is usually controlled by antihypertensive medication and diet.
A client will be taking nitrofurantoin 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? Increase the intake of fluids. Strain the urine for crystals and stones. Stop the drug if urinary output increases. Maintain the exact time schedule for taking the drug.
increase intake of fluids To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this drug. Straining urine is not indicated when the client is taking a urinary antiinfective. Urinary decrease is of concern because it may indicate renal failure. If fluids are encouraged, the client's output should increase. The drug need not be taken at a strict time daily.
Which is an abnormal finding of the urinary system? Nonpalpable left kidney Presence of bowel sounds Nonpalpable urinary bladder Pain in the flank region upon hitting
pain in the flank upon hitting Normally, a blow in the flank region should not elicit pain. Pain in the flank region upon hitting indicates kidney infection or polycystic kidney disease. But the client experiences pain when his/her flank area is hit; therefore, this is an abnormal finding. The left kidney is covered by the spleen and is not palpable, which is a normal finding. The client has bowel sounds. However, no alteration of bowel sounds is seen. Therefore it is a normal finding. The urinary bladder is not normally palpable, unless it is distended with urine.
A client is admitted to the hospital with a diagnosis of severe chronic kidney disease. Which assessment findings should the nurse expect the client to exhibit? Select all that apply? Polyuria Paresthesias Hypertension Metabolic alkalosis Widening pulse pressure
paresthesias, hypertension Paresthesias[1][2] occur as a result of excess nitrogenous wastes, altered fluid and electrolytes, and altered regulatory functions. Nonfunctioning kidneys cause fluid retention that may result in hypervolemia and hypertension. Polyuria occurs because of extensive nephron damage and may occur in the early stage of kidney disease but not in the severe stage. Metabolic acidosis, not alkalosis, results from the inability to excrete hydrogen ions and retain bicarbonate. Widening pulse pressure occurs with increased intracranial pressure, not with kidney dysfunction.
Which drug prescribed to a client with a urinary tract infection (UTI) turns urine reddish-orange in color? Amoxicillin Ciprofloxacin Nitrofurantoin Phenazopyridine
phenazopyridine Phenazopyridine is a topical anesthetic that is used to treat pain or burning sensation associated with urination. It also imparts a characteristic orange or red color to urine. Amoxicillin is a penicillin form that could cause pseudomembranous colitis as a complication; it is not associated with reddish-orange colored urine. Ciprofloxacin is a quinolone antibiotic used for treating UTIs and can cause serious cardiac dysrhythmias and sunburns. It is not, however, responsible for reddish-orange colored urine. Nitrofurantoin is an antimicrobial medication prescribed for UTIs. This drug may affect the kidneys but is not associated with reddish-orange colored urine.
What is the most important intervention to prevent hospital-acquired catheter-associated urinary tract infections (CAUTIs)? Removing the catheter Keeping the drainage bag off of the floor Washing hands before and after assessing the catheter Cleansing the urinary meatus with soap and water daily
removing the catheter Research demonstrates that decreasing the use of indwelling urinary catheters is the most important intervention to prevent hospital-acquired catheter-associated urinary tract infections (CAUTIs). Keeping the drainage bag off the floor, washing hands before and after assessing the catheter, and cleansing the urinary meatus daily with soap and water will help reduce infections; however, these are not the most important interventions to prevent CAUTIs.
The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure? A. Increase in BP B. decrease in erythropoietin C. increase in serum phosphate levels D. decrease in serum sodium
B. decrease in erythropoietin The hormone erythropoietin, produced by the kidneys, stimulates the bone marrow to produce red blood cells. In renal failure there is a deficiency of erythropoietin that often results in the client developing anemia. Therefore the nurse is instructed to administer blood. In renal failure, increased blood pressure is due to impairment of renal vasodilator factors and is not treated by administration of blood. Phosphate is retained in the body during renal failure, causing binding of calcium leading to done demineralization, not anemia. Increase in urinary sodium concentration and decrease in serum sodium concentration trigger the release of renin from the juxtaglomerular cells.
A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for which complication? Peritonitis Hepatitis B Renal calculi Bladder infection
Hepatitis B Hepatitis type B is transmitted by blood or blood products. The hemodialysis and routine transfusions needed for a client in end-stage renal failure constitute a high risk for exposure. Peritonitis is a danger for individuals receiving peritoneal dialysis. Renal calculi are not a complication of hemodialysis; they often occur in clients who are confined to prolonged bed rest. Dialysis does not involve the bladder and will not contribute to the development of a bladder infection.
A client with end-stage renal disease is hospitalized. For which complications should the nurse monitor the client? Select all that apply. Anemia Dyspnea Jaundice Hyperexcitability Hypophosphatemia
anemia, dyspnea Anemia results from decreased production of erythropoietin by the kidneys, which causes decreased erythropoiesis by bone marrow. Dyspnea is a result of fluid overload, which is associated with chronic kidney failure. Jaundice occurs with biliary obstruction or liver disorders, not with kidney failure. Lethargy occurs as a result of general depression of the central nervous system. Hyperphosphatemia occurs with kidney failure, not hypophosphatemia
The nurse is preparing a client who is on metformin therapy and is scheduled to undergo renal computed tomography with contrast dye. What does the nurse anticipate the primary healthcare provider to inform the client regarding the procedure? "Discontinue metformin 1 day prior to procedure." "Discontinue metformin a half-day prior to procedure." "Discontinue metformin 3 days following the procedure." "Discontinue metformin 7 days following the procedure."
discontinue 1 day prior Metformin can react with the iodinated contrast dye that is given for a renal computed tomography (CT) and cause lactic acidosis. Therefore the nurse anticipates an instruction that the client should discontinue the metformin 1 day before the procedure. Stopping the metformin a half-day before the renal CT may not reduce the risk of lactic acidosis. The client is advised to discontinue the metformin for at least 48 hours after the procedure. It is not necessary to discontinue metformin for 3 to 7 days after a renal CT with contrast media.
A registered nurse is teaching a client regarding preventive measures for genital tract infections. Which statement made by the client indicates the need for further education? Select all that apply. "I should take frequent bubble baths." "I should decrease the use of dietary sugar." "I should choose hosiery with a nylon crotch." "I should use colored and scented toilet tissues." "I should limit the time spent in damp exercise clothes."
frequent bubble baths, hosiery with a nylon crotch, colored/scented toilet tissue Exposure to bath salts and bubble baths should be limited to prevent genital tract infections. Hosiery with a cotton crotch should be selected to prevent genital tract infections because cotton fabric absorbs wetness. Colored and scented toilet tissues should be avoided because they can increase the risk of genital tract infections. The use of dietary sugar should be decreased to prevent genital tract infections. Damp exercise clothes should be removed immediately because they increase the risk of genital tract infections.
After treatment for a bladder infection, a client asks whether there is anything she can do to prevent cystitis in the future. What is the best response by the nurse? "Avoid regular use of tampons." "Decrease your intake of prune juice." "Increase your daily fluid consumption." "Cleanse the perineum from back to front."
increase daily fluid consumption Increasing fluid intake flushes the urinary tract of microorganisms. Tampons do not increase the risk of cystitis. Fluids should be increased, not decreased; prune juice promotes acidic urine, which is desirable because it discourages the growth of microorganisms. The preferred method of cleansing is from front to back (urethra to vagina); however, studies have shown that this method of cleansing is not a significant factor in the prevention of cystitis.
A nurse is caring for an older bedridden male client who is incontinent of urine. Which action should the nurse take first? Restrict fluid intake. Offer the urinal regularly. Apply incontinence pants. Insert an indwelling urinary catheter.
offer the urinal regularly Offering the urinal is the first step. Retraining the bladder includes a routine pattern of attempts to void, which may increase bladder muscle tone and produce a conditioned response. Restricting fluid intake can result in dehydration and a urinary tract infection in an older client. Applying incontinence pants does not address the cause of the incontinence; also it promotes skin breakdown and can lower self-esteem. Inserting an indwelling urinary catheter increases the risk of a urinary tract infection. Also, it requires a primary healthcare provider's prescription.
Which electrolyte deficiency triggers the secretion of renin? Sodium Calcium Chloride Potassium
sodium Low sodium ion concentration causes decreased blood volume, thereby resulting in decreased perfusion. Decreased blood volume triggers the release of renin from the juxtaglomerular cells. Deficiencies of calcium, chloride, and potassium do not stimulate the secretion of renin.
A nurse is caring for a client with end-stage renal disease. Which clinical indicators of end-stage renal disease should the nurse expect? Select all that apply. A. polyuria B. jaundice C. azotemia D. hypertension E. polycythemia
azotemia and hypertension Azotemia is an increase in nitrogenous waste, particularly urea, in the blood; this is common in end-stage renal disease. Hypertension occurs as a result of fluid and sodium overload and dysfunction of the rennin-angiotensin-aldosterone system. Excessive nephron damage in end-stage renal disease causes oliguria, not polyuria; excessive urination is common in early kidney insufficiency from an inability to concentrate urine. Jaundice is common with biliary obstruction, not end-stage renal disease. Anemia, not polycythemia, occurs because of decreased erythropoietin, decreased red blood cell (RBC) production, and decreased RBC survival time.
A nurse is notified that the latest potassium level for a client in acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action should the nurse take first? Alert the cardiac arrest team. Call the laboratory to repeat the test. Take vital signs and notify the primary healthcare provider. Obtain an electrocardiogram (ECG) strip and obtain an antiarrhythmic medication.
take vitals and notify provider Vital signs monitor the cardiopulmonary status; the primary healthcare provider must treat this hyperkalemia[1][2] to prevent cardiac dysrhythmias. The cardiac arrest team responds to a cardiac arrest; there is no sign of arrest in this client. A repeat laboratory test will take time and probably reaffirm the original results; the client needs medical attention. Although obtaining an ECG strip is appropriate, obtaining an antiarrhythmic is premature; vital signs and medical attention is needed first.
A client with kidney dysfunction is about to undergo renal testing using a contrast medium. Which nursing interventions should be conducted before the procedure to ensure the client's safety? Select all that apply. Assessing the client for a history of cirrhosis Asking the client if he or she has a known shellfish allergy Assessing the client for a history of lactic acidosis Assessing the client's hydration status by checking blood pressure and respiratory rate Asking the client to discontinue metformin 12 hours before the procedure
assessing for a history of cirrhosis, asking if they have a shellfish allergy, assessing hydration status While interviewing a client who is about to undergo kidney procedure using a contrast medium, the nurse should assess for a history of cirrhosis. Clients with cirrhosis have an increased chance of developing kidney failure after the procedure. The nurse should confirm any known shellfish allergies because contrast dye administered during the study may cause nephrotoxicity. It is not necessary to check the client for a history of lactic acidosis when ensuring the client's safety for renal testing. If the client had lactic acidosis currently, then this would be a significant factor when ensuring the client's safety for renal testing. The nurse should also assess the client's hydration status by checking blood pressure and respiratory rate. The nurse should ask the client to discontinue metformin 24 hours before the procedure to prevent lactic acidosis.
Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. When teaching about the medication, what does the nurse instruct the client to do? Drink 8 to 10 glasses of water daily. Drink two glasses of orange juice daily. Take the medication with meals. Take the medication until symptoms subside.
drink 8 to 10 glasses of water daily A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken 1 hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside.
A client reports urinary frequency and burning. To determine whether there is tenderness that indicates the presence of an ascending urinary tract infection, the nurse should palpate which area? Tail of Spence Suprapubic area McBurney point Costovertebral angle
costovertebral angle The costovertebral angle[1][2][3] (the angle formed by the lateral and downward curve of the lowest rib and the vertebral column of the spine itself) is percussed to determine whether there is tenderness in the area over the kidney; this can be a sign of glomerulonephritis or severe upper urinary tract infection. The tail of Spence extends from the upper outer quadrant of the breast to the axillary area; this is the most common site for tumors associated with cancer of the breast. The suprapubic area is above the symphysis pubis; it is palpated and percussed to assess for bladder distention. McBurney's point is 1 to 2 inches (2.5 to 5 cm) above the anterosuperior spine of the ileum on a line between the ileum and umbilicus; external pressure produces tenderness with acute appendicitis, not a kidney infection.
After reviewing the laboratory reports, the nurse anticipates that the client has renal impairment. Which test reports support the nurse's concern? Select all that apply. Serum albumin: 4.7 g/dL(6.815 µmol/L) Serum creatinine: 2.0 mg/dL (176.8 µmol/L) Serum potassium: 5.9 mEq/L (5.9 mmol/L) Serum cholesterol: 120 mg/dL (3.108 mmol/L) Blood urea nitrogen: 32 mg/dL (11.424 mmol/L)
creatinine of 2, potassium of 5.9, and BUN of 32 Renal impairment is marked by increased serum creatinine concentration, blood urea nitrogen, and potassium ion concentration levels. The normal serum creatinine concentration lies between 0.5 and 1.5 mg/dL (44.2-132.6 µmol/L). A serum creatinine value of 2.0 mg/dL (176.8 µmol/L) indicates renal impairment. The normal concentration of potassium ions in serum ranges from 3.5 to 5 mEq/L (3.5-5 mmol/L). A potassium ion concentration of 5.9 mEq/L(5.9 mmol/L) indicates kidney dysfunction. The normal value of blood urea nitrogen (BUN) lies between 7 and 20 mg/dL (2.45-7.14 mmol/L). A BUN value of 32 mg/dL (11.424 mmol/L) indicates renal impairment. The normal range of serum albumin concentration lies between 3.5 to 5.5 g/dL (5.075-7.975 µmol/L). A cholesterol value less than 200 mg/dL (5.18 mmol/L) is normal.
A client receiving hemodialysis undergoes surgery to create an arteriovenous fistula. Before discharge, the nurse discusses care at home with the client and his wife. Which statement by the client's wife indicates that further teaching is required? "I must touch the shunt several times a day to feel for the bruit." "I have to take his blood pressure every day in the arm with the fistula." "He will have to be very careful at night not to lie on the arm with the fistula." "We really should check the fistula every day for signs of redness and swelling."
i have to take his BP every day in the arm with the fistula Taking the blood pressure in the affected arm may injure the fistula. The presence of a bruit indicates that the circulation is not obstructed by a thrombus. Hemorrhage can occur in a matter of minutes if the cannula is dislodged. Redness and swelling are signs of infection, which is a complication of cannulization.
A client with limited mobility is being discharged. To prevent urinary stasis and formation of renal calculi, what should the nurse instruct the client to do? Increase oral fluid intake to 2 to 3 L/day. Maintain bed rest after discharge. Limit fluid intake to 1 L/day. Void at least every hour.
increase oral fluid intake to 2 to 3 L daily Increasing oral fluid intake to 2 to 3 L/day, if not contraindicated, will dilute urine and promote urine flow, thus preventing stasis and complications such as renal calculi. Bed rest and limited fluid intake may lead to urinary stasis and increase risk for the formation of renal calculi. Voiding at least every hour has no effect on urinary stasis and renal calculi.
A client with acute kidney injury is to receive peritoneal dialysis and asks why the procedure is necessary. Which is the nurse's best response? "It prevents the development of serious heart problems." "It helps perform some of the work usually done by the kidneys." "It will keep your kidneys from getting worse and may 'restart' your kidneys to perform better than before." "It speeds recovery because the kidneys are not responding to regulating hormones."
it helps perform some of the work usually done by the kidneys Dialysis removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Stating that peritoneal dialysis, "removes toxic chemicals from the body so you will not get worse," is threatening and can cause an increase in anxiety. Dialysis helps maintain fluid and electrolytes; the nephrons are damaged in acute kidney injury, so it may or may not speed recovery.
A student nurse is caring for a client with chronic kidney failure who is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the student nurse indicates to the primary nurse that the student nurse understands the purpose of this therapy? "It provides continuous contact of dialyzer and blood to clear toxins by ultrafiltration." "It exchanges and cleanses blood by correction of electrolytes and excretion of creatinine." "It decreases the need for immobility, because it clears toxins in short and intermittent periods." "It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion."
it uses the peritoneum Diffusion[1][2] moves particles from an area of greater concentration to an area of lesser concentration; osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.
After reviewing the urinalysis reports of a client with a renal disorder, the nurse concludes that the client may have a urinary tract infection. Which urinary laboratory findings enabled the nurse to make this conclusion? Select all that apply. pH: 8.5 Specific gravity: 1.010 Red blood cells: 3/hpf Osmolality: 1500 mOsm/kg (1500 mmol/kg) White blood cells: 6/hpf
pH 8.5 and WBC 6 The client may have a urinary tract infection, as the urinalysis reports show the presence of pH as 8.5 and white blood cells as 6/hpf in the urine. A pH above 8.0 indicates a urinary tract infection; client's is 8.5. The normal level of white blood cells (WBC) in urine should be less than 5/hpf; therefore, the WBC level of 6/hpf indicates urinary tract infection. The specific gravity of 1.010 indicates a normal finding. The normal level of red blood cells (RBC) is less than 4/hpf; therefore, the RBC levels of 3/hpf indicates normal finding. Osmolality of 1500 mOsm/kg (1500 mmol/kg) indicates tubular dysfunction.
The nurse understands that the best way to reduce catheter-associated urinary tract infections (CAUTIs) in long-term indwelling catheters is to do what? Perform catheter care twice a day. Replace the catheter on a routine basis. Administer cranberry tablets three times each day. Give antibiotics for the duration of catheter placement.
perform catheter care twice a day A bacterial biofilm develops in long-term indwelling catheters increasing the risk of catheter-associated urinary tract infection (CAUTI). The best way to eliminate this risk is to perform routine perineal hygiene and catheter care every day. Routine replacement of indwelling urinary catheters increases CAUTI risk. The efficacy of cranberry tablets in decreasing the frequency of urinary tract infections has not been established. Antibiotic therapy may increase the growth of microbes within the biofilm.
A nurse is reviewing the laboratory reports of a client with a diagnosis of end-stage renal disease. Which test result should the nurse anticipate? Arterial pH of 7.5 Hematocrit of 54% Potassium of 6.3 mEq/L (6.3 mmol/L) Creatinine of 1.2 mg/dL (106 mcmol/L)
potassium of 6.3 Clients with end-stage renal disease have impaired potassium excretion, so the nurse should anticipate a potassium level more than the expected range of 3.5 to 5 mEq/L (3.5 to 5 mmol/L). Clients with end-stage renal disease usually have a serum pH that is less than 7.35 because of metabolic acidosis. A pH of 7.5 that exceeds the expected range of 7.35 to 7.45 is not anticipated because this is alkalosis. Clients with end-stage renal disease have decreased erythropoietin, which leads to decreased red blood cell production and hematocrit; a hematocrit of 54% exceeds the expected range, which is 39% to 50% for males and 35% to 47% for females; therefore, it is not anticipated. Clients with end-stage renal disease have a decreased ability to eliminate nitrogenous wastes, which leads to increased creatinine levels; a creatinine level of 1.2 mg/dL (106 mcmol/L) is within the expected range of 0.7 to 1.4 mg /dL (62 to 124 mcmol/L) and therefore is not anticipated.
Which intervention would be most beneficial in preventing a catheter-associated urinary tract infection in a postoperative client? Pouring warm water over the perineum Ensuring the patency of the catheter Removing the catheter within 24 hours Cleaning the catheter insertion site
removing the catheter within 24 hours Clients who undergo surgery are at a greater risk of acquiring catheter-associated urinary tract infections. Infections can be prevented by removing the catheter within 24 hours, if the client does not need it. Therefore removing the catheter within 24 hours would be the best intervention. While pouring warm water over the perineum helps voiding in the postoperative client and also reduces the chances of infection, this action would not be as beneficial as the former intervention. The catheter should be maintained in its place to avoid leakage and infection. Cleaning the catheter insertion site will definitely reduce the risk of infection, but this action cannot prevent infections if the catheter is inserted for a long time.
Which statement is true regarding the functions of kidney hormones? Prostaglandin increases blood flow and vascular permeability Bradykinin regulates intrarenal blood flow via vasodilation or vasoconstriction Renin raises blood pressure because of angiotensin and aldosterone secretion. Erythropoietin promotes the absorption of calcium in the gastrointestinal tract (GI) tract.
renin raises BP Renin is a kidney hormone that raises blood pressure as a result of angiotensin and aldosterone secretion. Prostaglandin is a kidney hormone that regulates intrarenal blood flow via vasodilation or vasoconstriction. Bradykinin is a kidney hormone that increases blood flow and vascular permeability. Erythropoietin is a kidney hormone that stimulates the bone marrow to make red blood cells.
A client has undergone pelvic surgery and the nurse removes the catheter in a week according to instructions. In the follow up within several hours, which finding in the client indicates a need for reinsertion of catheter? Anuria Polyuria Retention Incontinence
retention The inability of the client to urinate in spite of the bladder being filled with urine is called retention. Generally clients who have undergone pelvic surgery and have the catheter removed experience urinary retention. The catheter should be reinserted if the client is unable to void. Anuria is the drastic decrease in urine output to less than 100 mL in a day and is a sign of end-stage kidney disease or acute kidney injury. Polyuria is anticipated in a client who is diagnosed with diabetes mellitus or insipidus, and the client eliminates large volumes of urine at a time. Incontinence or the loss of ability over voluntarily control of urination is a sign of conditions such as neurogenic bladder or bladder infection.
A nurse is providing client teaching to a woman who has recurrent urinary tract infections. Which information should the nurse include concerning the reason why women are more susceptible to urinary tract infections than men? Inadequate fluid intake Poor hygienic practices The length of the urethra The continuity of mucous membranes
the length of the urethra The length of the urethra is shorter in women than in men; therefore, microorganisms have a shorter distance to travel to reach the bladder. The proximity of the meatus to the anus in women also increases the incidence of urinary tract infections. Fluid intake may or may not be adequate in both men and women and does not account for the difference. Hygienic practices can be inadequate in men or women. Mucous membranes are continuous in both men and women.
A client's medication history includes a cholinergic medication. The client states, "I take that for some kind of urinary problem." The nurse recalls that cholinergic medications are prescribed primarily for what type of urinary condition? Kidney stones Urine retention Spastic bladder Urinary tract infections
urinary retention Cholinergics intensify and prolong the action of acetylcholine, which increases the tone in the genitourinary tract, preventing urinary retention. Cholinergics will not prevent renal calculi. Anticholinergics are prescribed for the frequency and urgency associated with a spastic bladder. Preventing urinary tract infections is a secondary gain because cholinergics help prevent urinary retention that can lead to a urinary tract infection, but this is not the primary purpose for administering these drugs.
To help prevent a cycle of recurring urinary tract infections in a female client, which instruction should the nurse share? "Urinate as soon as possible after intercourse." "Increase your daily intake of citrus juice." "Douche regularly with alkaline agents." "Take bubble baths regularly."
urinate as soon as possible after intercourse Intercourse may cause urethral inflammation, increasing the risk of infection; voiding clears the urinary meatus and urethra of microorganisms. Most fruit juices, with the exception of cranberry juice, cause alkaline urine, which promotes bacterial growth. Douching is no longer recommended because it alters the vaginal flora. Bubble baths can promote urinary tract infections.
A female client has a history of recurrent urinary tract infections. What should the nurse include in the teaching plan when educating the client about health practices that may help decrease future urinary tract infections? "Wear cotton underpants." "Void at least every 6 hours." "Increase foods containing alkaline ash in the diet." "Wipe from back to front after toileting."
wear cotton underpants Cotton allows air to circulate and does not retain moisture the way synthetic fabrics do; microorganisms multiply in warm, moist environments. Voiding frequently helps to flush ascending microorganisms from the bladder, thereby reducing the risk for urinary tract infections; holding urine for 6 hours can lead to urinary tract infections. Foods high in acid, not alkaline, ash help to acidify urine; this urine is less likely to support bacterial growth. Alkaline urine promotes bacterial growth. Wiping from back to front after toileting may transfer bacteria from the perianal area toward the urinary meatus, which will increase the risk for urinary tract infection.
A client is to have hemodialysis. What must the nurse do before this treatment? Obtain a urine specimen to evaluate kidney function. Weigh the client to establish a baseline for later comparison. Administer medications that are scheduled to be given within the next hour. Explain that the peritoneum serves as a semipermeable membrane to remove wastes.
weight the client A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.
